Congying Xia1, Marleen Vonder2, Gert Jan Pelgrim3, Mieneke Rook4, Xueqian Xie5, Abdullah Alsurayhi6, Peter M A van Ooijen7, Jurjen N van Bolhuis8, Matthijs Oudkerk9, Monique Dorrius10, Pim van der Harst11, Rozemarijn Vliegenthart12. 1. University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands. Electronic address: c.xia@umcg.nl. 2. University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands. Electronic address: m.vonder@umcg.nl. 3. University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands. Electronic address: g.j.pelgrim@umcg.nl. 4. University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands; Department of Radiology, Martini Hospital Groningen, Groningen, the Netherlands. Electronic address: m.rook@umcg.nl. 5. Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: xiexueqian@hotmail.com. 6. University of Groningen, Faculty of Medical Sciences, Groningen, the Netherlands. Electronic address: a.a.alsurayhi@student.rug.nl. 7. University of Groningen, University Medical Center Groningen, Department of Radiation Therapy, Groningen, the Netherlands. Electronic address: p.m.a.van.ooijen@umcg.nl. 8. Lifelines Cohort Study, Groningen, the Netherlands. Electronic address: j.n.van.bolhuis@lifelines.nl. 9. University of Groningen, Faculty of Medical Sciences, Groningen, the Netherlands; Institute for Diagnostic Accuracy, Groningen, the Netherlands. Electronic address: m.oudkerk@rug.nl. 10. University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands. Electronic address: m.d.dorrius@umcg.nl. 11. University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands. Electronic address: p.van.der.harst@umcg.nl. 12. University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands. Electronic address: r.vliegenthart@umcg.nl.
Abstract
BACKGROUND: To determine the effect of low-dose, high-pitch non-electrocardiographic (ECG)-triggered chest CT on coronary artery calcium (CAC) detection, quantification and risk stratification, compared to ECG-triggered cardiac CT. METHODS: We selected 1,000 participants from the ImaLife study, 50% with coronary calcification on cardiac CT. All participants underwent non-contrast cardiac CT followed by chest CT using third-generation dual-source technology. Reconstruction settings were equal for both acquisitions. CAC scores were determined by Agatston's method, and divided dichotomously (0, >0), and into risk categories (0, 1-99, 100-399, ≥400). We investigated the influence of heart rate and body mass index (BMI) on risk reclassification. RESULTS: Positive CAC scores on cardiac CT ranged from 1 to 6926 (median 39). Compared to cardiac CT, chest CT had sensitivity of 0.96 (95%CI 0.94-0.98) and specificity of 0.99 (95%CI 0.97-0.99) for CAC detection (κ = 0.95). In participants with coronary calcification on cardiac CT, CAC score on chest CT was lower than on cardiac CT (median 30 versus 40, p˂0.001). Agreement in CAC-based risk strata was excellent (weighted κ = 0.95). Sixty-five cases (6.5%) were reclassified by one risk category in chest CT, with fifty-five (84.6%) shifting downward. Higher BMI resulted in higher reclassification rate (13% for BMI ≥30 versus 5.2% for BMI <30, p = 0.001), but there was no effect of heart rate. CONCLUSION: Low-dose, high-pitch chest CT, using third-generation dual-source technology shows almost perfect agreement with cardiac CT in CAC detection and risk stratification. However, low-dose chest CT mainly underestimates the CAC score as compared to cardiac CT, and results in inaccurate risk categorization in BMI ≥30.
BACKGROUND: To determine the effect of low-dose, high-pitch non-electrocardiographic (ECG)-triggered chest CT on coronary artery calcium (CAC) detection, quantification and risk stratification, compared to ECG-triggered cardiac CT. METHODS: We selected 1,000 participants from the ImaLife study, 50% with coronary calcification on cardiac CT. All participants underwent non-contrast cardiac CT followed by chest CT using third-generation dual-source technology. Reconstruction settings were equal for both acquisitions. CAC scores were determined by Agatston's method, and divided dichotomously (0, >0), and into risk categories (0, 1-99, 100-399, ≥400). We investigated the influence of heart rate and body mass index (BMI) on risk reclassification. RESULTS: Positive CAC scores on cardiac CT ranged from 1 to 6926 (median 39). Compared to cardiac CT, chest CT had sensitivity of 0.96 (95%CI 0.94-0.98) and specificity of 0.99 (95%CI 0.97-0.99) for CAC detection (κ = 0.95). In participants with coronary calcification on cardiac CT, CAC score on chest CT was lower than on cardiac CT (median 30 versus 40, p˂0.001). Agreement in CAC-based risk strata was excellent (weighted κ = 0.95). Sixty-five cases (6.5%) were reclassified by one risk category in chest CT, with fifty-five (84.6%) shifting downward. Higher BMI resulted in higher reclassification rate (13% for BMI ≥30 versus 5.2% for BMI <30, p = 0.001), but there was no effect of heart rate. CONCLUSION: Low-dose, high-pitch chest CT, using third-generation dual-source technology shows almost perfect agreement with cardiac CT in CAC detection and risk stratification. However, low-dose chest CT mainly underestimates the CAC score as compared to cardiac CT, and results in inaccurate risk categorization in BMI ≥30.
Authors: Claudia Morf; Thomas Sartoretti; Antonio G Gennari; Alexander Maurer; Stephan Skawran; Andreas A Giannopoulos; Elisabeth Sartoretti; Moritz Schwyzer; Alessandra Curioni-Fontecedro; Catherine Gebhard; Ronny R Buechel; Philipp A Kaufmann; Martin W Huellner; Michael Messerli Journal: Diagnostics (Basel) Date: 2022-08-03